Preventive strategies of bile duct injury in emergent laparoscopic operations for severe acute cholecystitis

Abstract

Severe acute cholecytitis (SAC) is the severe type of acute cholecystitis, of which the pathological changes are both severe and complicated, resulting in poor response to conservative treatment. In the recent decade, emergent early laparoscopic cholecystectomy (LC) for SAC is getting more and more attention, but this procedure has both technique difficulties and a relatively high rate of complications including bile duct So specific treatment and technical strategy are needed for LC management of SAC. For SAC, the main objective of emergent LC is to achieve prompt drainage of the gallbladder to alleviate the systemic inflammatory response. Complete removal of stones and gallbladder tissue should depend on the individual condition during LC, and should not be overtreated. The technical strategies for SAC includedome-downdissection technique, subtotal cholecytectomy,inside approach of the gallbladdertechnique, partial cholecystectomy and crocodile mouth shape incision of gallbladder. Although the names of these technical strategies are different, but the main focus is the same, that is,trying not to touch calot's triangle, not to dissect the cystic duct, with residual gallbladder wall in exchange for clinical safety, the core of which is tobypass the calot's triangle to prevent bile duct injury. In practice, multiple strategies are often applied in a mixed way. Key words: Severe acute cholecystitis; Laparoscopic cholecystitis; Bile duct injury; Concept; Strategy